Concussion Recovery

[James]

Stop trying to justify you are OK and tough, take care and make sure you are (in this case don’t be old school).

By doing what exactly?

 

[Doug Briggs]

Concussion patients, by definition, are the last person that should be evaluating their condition. Concussion recovery is about resting the brain, not using it to evaluate itself.

 

[SBrown]

I'm just trying to picture what would happen if James's brain activity actually slowed down. It would be some sort of disturbance in the force. The Earth may spin off its axis or something. Be careful what you wish for!

 

[Tricia]

I'm just trying to picture what would happen if James's brain activity actually slowed down. It would be some sort of disturbance in the force. The Earth may spin off its axis or something. Be careful what you wish for!

I know, right!!

 

[raytseng]

Concussion patients, by definition, are the last person that should be evaluating their condition. Concussion recovery is about resting the brain, not using it to evaluate itself.

This is true, but the opposite is actually true too. If you assume all the drastic factors are normal. Nobody but yourself knows whats going on jn your brain, nobody can evaluate how you are feeling and doing except yourself. All the small effects only you can report what you are struggling with and you do need to selfevaluate to plan your own recovery and when/what you need to get help with. Maybe in 50years with fMRIs we can tell really read minds but not today.
You cannot examine a person and say that person has a headache, or feeling foggy or whatever. Especially with no physical scars they look normal. That was the biggest response I got from my friends and coworkers kept saying you look and sound fine i cant tell, when in fact it was taking way way more energy to do anything.

 

[raytseng]

By doing what exactly?

no drugs, no alcohol, no nsaids except for acetaminophen, for at least a month (due to blood thinning). No alcohol might be forever.
dont isolate yourself, both for emergency help and mental/social health.
dont do anything that has any risk of hitting your head again for awhile
dont go out to some remote trip where if you do stroke out there is no emergency services

encouraged to return to normal activities and tasks as soon as symptom free and doesn't provoke symptoms (headaches). If your body is fine you can return to physical exercise a lot sooner then you think like take a walk or treadmill or stationary bike or weight machines you are not an invalid comfined to a bed or couch. Doing a physical workouts of this sort is good for your body and should not be stressing your brain.

 

[Doug Briggs]

Concussion patients, by definition, are the last person that should be evaluating their condition. Concussion recovery is about resting the brain, not using it to evaluate itself.

This is true, but the opposite is actually true too. If you assume all the drastic factors are normal. Nobody but yourself knows whats going on jn your brain, nobody can evaluate how you are feeling and doing except yourself. All the small effects only you can report what you are struggling with and you do need to selfevaluate to plan your own recovery and when/what you need to get help with. Maybe in 50years with fMRIs we can tell really read minds but not today.
You cannot examine a person and say that person has a headache, or feeling foggy or whatever. Especially with no physical scars they look normal. That was the biggest response I got from my friends and coworkers kept saying you look and sound fine i cant tell, when in fact it was taking way way more energy to do anything.

I see your point about , however, I respectfully disagree.

While it is important for a concussion patient to report how they are feeling, their reasoning is most always negatively affected. Your friends and coworkers meant well however they sound like they were unfamiliar with concussions and their treatment. That is one of the reasons I stop on the trail and talk to the friends of victims when their friend has obviously experienced a potential impact to the head. Most are unaware that they need to monitor their friend for days, if not weeks. Concussion victims are classic deniers of their injury specifically due to the nature of the injury itself.

I'll modify my statement to say a concussion patient should be resting and not evaluating his condition other than to report the sensations necessary for his care givers to evaluate his situation. Rest and allowing others to care for you is exactly what the medical personnel I have dealt with following my recent concussions advise. You can't be resting the brain while attempting to make health decisions. Trying to maintain 'life as usual' and thinking the victim can determine his own condition is the wrong approach to concussion recovery. The victim shouldn't be making the decisions regarding his care as he is almost always not fully in control of his faculties.

I've had an athlete tell me he is just fine and ready to drive home moments before the medical personnel handling him have arranged an ambulance to take him to the hospital. In another situation, I was riding the gondola off the mountain one day when a couple were discussing a fall one of them had taken where she had hit her head. I pointed out that the nausea that the woman was experiencing was a possible symptom of concussion. The concussed, and often their companions, can't be relied upon to make the correct evaluations and decisions about their injury.

 

[raytseng]

I see your point and i think we agree. Ultimately though if you want to separate initial response/first aid vs recovery that 2 different scenarios and guidelines. For the first aid scenario, you are absolutely right, but i'd attribute it more to a matter of medical education and that the patient and friends don't know medical protocols. A person having a mild heart attack may often say I'm fine its just stress and a sore arm and walk it off; that's because of ignorance not brain damage. A lot of other injuries too, the adrenaline will mask what's going on, so this is a general ignorance issue.

Switching gears, in the recovery phase, after being evaluated and discharged and given education and instructions, this is where it ultimately does shift to the patient to follow doctors orders and only do X based on Y. In the concussion recovery, the Y in this case is all the patient's self-evaluation and I felt was simple, if you are symptom free slowly return to more normal activities, if you have symptoms step back down; err on the conservative side but you are encouraged to get back versus over-resting. It's doesn't follow any timeline or lab tests or anything like that for a caretaker to interpret. Caretaker helps you so you don't HAVE to do things, like make food or drive you to your appointments; so you are not forced to do an activity before you are ready.

I suppose an exception is with a child, because children generally have poor judgement and can't/won't follow instructions; so a parent can prevent them from going to soccer practice, but that is impossible to apply to a functioning adult. But this is the same patient compliance/ judgement issue as with non brain injuries. A person who has a liver transplant starts drinking against orders is not due to brain being affected during the transplant, that is just their inherent bad judgement /stubbornness /personality whatever you want to call it.

One point though in your favor, is an instruction post TBI to watch out for possible shift in behavior and personality e.g. depression. But that also is up to the patient to self report and use their inherent judgement to decide to take action on that. It cannot be evaluated by a caregiver if the patient wants to hide it.

 

[James]

Initially, there’s no doubt I was not mentally competent to evaluate anything. Ideally, someone would have seen it and intervened and called patrol.

There’s no logic. Since I wasn’t in pain, didn’t know I’d been unconscious, didn’t know I’d been hit, I basically skied off. I wonder about the goggles. They definitely were up on the helmet on that run. Did they fall off and I readjusted, or did they stay on? Even if they’d fallen off, it wouldn’t necess spark “why?” as it’s normal I have to put them back up occasionally.

At the end, after talking to the parents, I’m not sure I even would have gone to first aid. It’s weird, I had to use a written list for names, didn’t remember how I got down, but until someone mentioned I got hit and going to first aid I don’t know if I would have gone.

Note the kid who hit me and was unconscious for “a minute”, just skied off. Likely never mentioned it to parents. He definitely didn’t go to first aid.

Later is different though.
In terms of the CT scan. I talked to 4 doctors, 3 informally that I know, including one with 10 yrs as an ER doc, and one in the ER as a patient. Not one thought I needed a CT scan, let alone must get one.
My understanding is you’re looking for issues that will escalate quickly or require immediate attention. Fractures, bleeding, swelling.

Maybe that’s the difference between practicing medicine and reading about it. Reading we get the 1 in 7000 cases, and focus on the exception. In practice, there needs to be compelling evidence the patient is that one in 7000. (See below) At + 48hrs, that number must be many many times 7000.

Radiation exposure of a CT head scan, while still low, is about 100 chest x-rays.

From what I understand, an mri would actually show stuff. Ok, what are you going to do with the information? Likely no insurance is going to cover it, and they’re very expensive. There’s no radiation issue.
This doesn’t mean things can’t go south and symptoms come up warranting a CT scan.

From the Canadiens:
———————-
CT Scans for Adults with Head Injuries: When you need one—and when you don’t

CT scans can show if there is swelling or bleeding in the brain or a fracture in the skull. If you have signs of a serious injury, a CT scan is usually the best first test to diagnose it. Your health care provider will look for specific signs of a more serious problem. These include:
or bleeding in the brain. Most people with head injuries do not have either of these problems, and simple concussions do not show up on a CT scan.

If you do not have any of these signs, research shows your risk of a serious injury needing surgery or leading to serious complications is less than 1 in 7000, and a CT scan is unlikely to be helpful.

A thorough examination by a health care provider is the most important step to rule out
a serious injury. Your health care provider will examine you for a possible concussion or more serious injuries. If you are able to walk and talk normally, the chance of you having a serious injury needing surgery or special treatment is very low.

• Weakness on one side of your face or body
• Trouble speaking, hearing, or swallowing
• Reduced vision
• Seizures
• Repeated vomiting
• Severe headache
• One pupil larger than the other
• Fluid or blood from an ear or nose
• Tenderness over the skull
• Being on a blood thinner
———————————————

https://choosingwiselycanada.org/wp-content/uploads/2017/06/CTs-for-adults-with-head-injuries-EN.pdf

 

[Jerez]

My husband's concussion symptoms didn't show up for 3 or 4 days after his hit. Manifested as vertigo, morphed into just dizziness, headaches and fatigue, and resolved with physical therapy and several months of following a concussion protocol if limiting screen and reading time and lots of sleep and very gentle exercise, like waking and adding a few minutes to it until symptoms returned. Then back off and try again. It was excruciatingly slow process.

 

[oldschoolskier]

Initially, there’s no doubt I was not mentally competent to evaluate anything. Ideally, someone would have seen it and intervened and called patrol.

There’s no logic. Since I wasn’t in pain, didn’t know I’d been unconscious, didn’t know I’d been hit, I basically skied off. I wonder about the goggles. They definitely were up on the helmet on that run. Did they fall off and I readjusted, or did they stay on? Even if they’d fallen off, it wouldn’t necess spark “why?” as it’s normal I have to put them back up occasionally.

At the end, after talking to the parents, I’m not sure I even would have gone to first aid. It’s weird, I had to use a written list for names, didn’t remember how I got down, but until someone mentioned I got hit and going to first aid I don’t know if I would have gone.

Note the kid who hit me and was unconscious for “a minute”, just skied off. Likely never mentioned it to parents. He definitely didn’t go to first aid.

Later is different though.
In terms of the CT scan. I talked to 4 doctors, 3 informally that I know, including one with 10 yrs as an ER doc, and one in the ER as a patient. Not one thought I needed a CT scan, let alone must get one.
My understanding is you’re looking for issues that will escalate quickly or require immediate attention. Fractures, bleeding, swelling.

Maybe that’s the difference between practicing medicine and reading about it. Reading we get the 1 in 7000 cases, and focus on the exception. In practice, there needs to be compelling evidence the patient is that one in 7000. (See below) At + 48hrs, that number must be many many times 7000.

Radiation exposure of a CT head scan, while still low, is about 100 chest x-rays.

From what I understand, an mri would actually show stuff. Ok, what are you going to do with the information? Likely no insurance is going to cover it, and they’re very expensive. There’s no radiation issue.
This doesn’t mean things can’t go south and symptoms come up warranting a CT scan.

From the Canadiens:
———————-
CT Scans for Adults with Head Injuries: When you need one—and when you don’t

CT scans can show if there is swelling or bleeding in the brain or a fracture in the skull. If you have signs of a serious injury, a CT scan is usually the best first test to diagnose it. Your health care provider will look for specific signs of a more serious problem. These include:
or bleeding in the brain. Most people with head injuries do not have either of these problems, and simple concussions do not show up on a CT scan.

If you do not have any of these signs, research shows your risk of a serious injury needing surgery or leading to serious complications is less than 1 in 7000, and a CT scan is unlikely to be helpful.

A thorough examination by a health care provider is the most important step to rule out
a serious injury. Your health care provider will examine you for a possible concussion or more serious injuries. If you are able to walk and talk normally, the chance of you having a serious injury needing surgery or special treatment is very low.

• Weakness on one side of your face or body
• Trouble speaking, hearing, or swallowing
• Reduced vision
• Seizures
• Repeated vomiting
• Severe headache
• One pupil larger than the other
• Fluid or blood from an ear or nose
• Tenderness over the skull
• Being on a blood thinner
———————————————

https://choosingwiselycanada.org/wp-content/uploads/2017/06/CTs-for-adults-with-head-injuries-EN.pdf

@James, remember your first post, 5-10 minutes, twitching (seizure...5-10minutes).........

 

[raytseng]

I have had many concussions over the years with the last three (four) being the worst.
...
Every time I went to the ER they said "treat it" but they never suggested any action. It is frustrating now because concussions have recently become a concern. Seeing my Neurologist in a few days. Maybe we can look more closely at this stuff.

If you are still having issues what you need to ask about is post concussion therapy.
The medical doctors don't have any medical procedures to help you, just like if you lose an arm they can't regrow your arm. But there are therapies out there that can help you with exercises to potentially retrain the neurons you do have, or techniques and tricks you can try workaround the issues that bother you. Some therapy may just be psychiatric in nature rather than physical. There are also for-profit companies as well that you can look at. if you search for post concussion therapy, these compamies will come up.

 

[no edge]

My stroke occurred nearly three years ago (I think), the last concussion, four years. It seems like too much time has passed. Is that logic accurate?

You have raised some good points.

I have serious and persistent head aches. I eat three Tylenol per day. I try hard to limit it to that. I have been warned by doctors about relying on Tylenol, but it works. I cannot take aspirin. Three is just enough to manage the pain. I drink a cup of coffee with the Tylenol, and that helps too.

The balance aspect of this situation is a drag. I tip to the left. I have fallen down the stairs and needed knee surgery. I have also fallen catching myself. I have tipped over into other people... awkward. But skiing still works and helps me to stay focused and remain in the moment. I am thankful that skiing is still a part of my life. Some (or one) people have suggested that I dwell on the problem there by giving it more power.

Then there is memory and speech. Sometimes there is a complete blank on people I know quite well. Not family but the other day... my boss for whom I have total respect - my friend and supporter - the name just wasn't there. That was friggin frustrating. I often show what seems to be laziness by slashing a word and just saying the first syllable or changing to an unrelated word. These are day to day frustrating experiences.

I think it's a combination of stroke and concussion. So it's "onward through the fog."

 

[James]

My stroke occurred nearly three years ago (I think), the last concussion, four years. It seems like too much time has passed. Is that logic accurate?

You have raised some good points.

I have serious and persistent head aches. I eat three Tylenol per day. I try hard to limit it to that. I have been warned by doctors about relying on Tylenol, but it works. I cannot take aspirin. Three is just enough to manage the pain. I drink a cup of coffee with the Tylenol, and that helps too.

The balance aspect of this situation is a drag. I tip to the left. I have fallen down the stairs and needed knee surgery. I have also fallen catching myself. I have tipped over into other people... awkward. But skiing still works and helps me to stay focused and remain in the moment. I am thankful that skiing is still a part of my life. Some (or one) people have suggested that I dwell on the problem there by giving it more power.

Then there is memory and speech. Sometimes there is a complete blank on people I know quite well. Not family but the other day... my boss for whom I have total respect - my friend and supporter - the name just wasn't there. That was friggin frustrating. I often show what seems to be laziness by slashing a word and just saying the first syllable or changing to an unrelated word. These are day to day frustrating experiences.

I think it's a combination of stroke and concussion. So it's "onward through the fog."

You could see if you qualify for a study. Whether that helps or not, no idea, but it would get you closer to people working on these issues.
This is primarily in the DC area, but may have sites around the country:

Participation

www.cnrmstudies.org

Another funded mostly by the Dept of Defense:

Brain Trauma Foundation - Contact Us — Brain Trauma Foundation

www.braintrauma.org

There's these two places, Boston or NY.

If you are in the Boston area I would recommend making an appointment at - https://www.bidmc.org/centers-and-d.../concussion-and-traumatic-brain-injury-clinic

If you are close to NYC, I would see someone at - https://concussion.weillcornell.org/

I'm sure there are many more around the country.

Then there's this guy, Dr Amen, "as seen on tv".
He claims to be able to do things like retrain your brain. I have no doubt that at some point in the future there will be specific things to do other than be a couch potato not looking at anything. Whether he's just making money or not, no idea. It's not like the rest of medicine is not for profit anyway.

He does SPECT imaging. Then a protocol-
--------------
We have many Concussion Rescue Protocol treatment options that will be recommended by your doctor and may include the following solutions:

• Hyperbaric Oxygen Therapy (HBOT)
• Neurofeedback
• Post-TBI Hormone Evaluation
• Medication Management and Pharmacology
• Targeted Nutraceuticals
• IV Therapies

-----------------------------------
www.amenclinics.com/services/concussion-rescue-program/
The imaging and some treatment is going to be around $4k I think.

Anyone have any info on them?

 

[raytseng]

You can possivly benefit and get improvement from therapy even years or decades after the incident. If the therapy is just with strategy to prevent any further decline that is helpful in itself too.
There are some new studies that beyond neuroplasticity, new neurons can grow even in adults and not just young people, so even (some) old dogs can be taught new tricks. The brain is still a mystery, this is all new research and every person is different with a spectrum of possibility. Other than cost, there is no downside to at least inquiring.

This company came up in my search. Its looks forprofit and Im not specifically recommending it, but they have some testimonials explaining some of their exercises and stories from their best results so you get an idea of what actually happens. It is exercises and drills and techniques, it isn't going to be magic or a pill.

The Cognitive FX Blog

Your source for everything you need to know about traumatic brain injury and concussions.

www.cognitivefxusa.com

 

[no edge]

This company came up in my search. Its looks forprofit and Im not specifically recommending it, but they have some testimonials explaining some of their exercises and stories from their best results so you get an idea of what actually happens. It is exercises and drills and techniques, it isn't going to be magic or a pill.

The Cognitive FX Blog

Your source for everything you need to know about traumatic brain injury and concussions.

www.cognitivefxusa.com

Wow that looks like an huge source of info for concussions and brain injuries. Thanks. I will follow up.

 

[James]

You can possivly benefit and get improvement from therapy even years or decades after the incident. If the therapy is just with strategy to prevent any further decline that is helpful in itself too.
There are some new studies that beyond neuroplasticity, new neurons can grow even in adults and not just young people, so even (some) old dogs can be taught new tricks. The brain is still a mystery, this is all new research and every person is different with a spectrum of possibility. Other than cost, there is no downside to at least inquiring.

This company came up in my search. Its looks forprofit and Im not specifically recommending it, but they have some testimonials explaining some of their exercises and stories from their best results so you get an idea of what actually happens. It is exercises and drills and techniques, it isn't going to be magic or a pill.

The Cognitive FX Blog

Your source for everything you need to know about traumatic brain injury and concussions.

www.cognitivefxusa.com

Looks pretty good. I suspect this type if thing is where we’re headed. It’s a ripe field for fraud however. Not that I think they are. A week there which includes two fMri’s, is $9k-$13k with likely no coverage.

Any info on whether fMri’s really show or represent what they claim?

 

[SkiNurse]

Couple of things, initial study published in 2012 in New South Wales, this is just the document saying to adopt in Ontario 2018, Canada. FYI, expect something new coming out as a result of Rowens Law in Canada (missed concussion followed by a second little bump caused a death resulting in this law after a lawsuit). Slight bump and no other symtoms are considered serious and have legal repercussions that action MUST be taken.

Second search up seizure in the document and you fall under HIGH RISK MILD HEAD INJURY, follow chart on right side.

Finally, prolonged is something that is longer than minute (our understand after dealing with seizures), 5 minutes is serious concern and 10 minutes doctors really start to worry.

LAYMANS TERMS

Momentary is a reset of the brain, can be good as it prevents damage to brain, you’re brain glitching and brain resets to protect itself.

Longer, damage starts because other functions (blood flow, O2 intake....etc) are interrupted and this causes cell death all over, including the brain. Think of this as the dreaded Blue Screen Of Death. Depending on length and which areas suffer the most determines outcome. (Side note we can see O2 drop in body in less than a minute of seizure to below OMG 92% that starts getting doctors excited).

So even by your own research take this SERIOUSLY! Few hundred dollars / few thousand dollars (no new equipment or skiing for a year or two), big deal, beats not skiing ever again because of missed, hidden, surprise complications . This is a no brainer.

Stop trying to justify you are OK and tough, take care and make sure you are (in this case don’t be old school).

Amen

 

[Nancy Hummel]

James, your treament and diagnostics should be covered by Workers’ Compensation. Has your employer sent you to a doctor?

 

[James]

Yes